Latest News - Part 7

Care of the Critically ill and Injured During Pandemics and Disasters: Strategies

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Care of the Critically ill and Injured During Pandemics and Disasters: StrategiesStrategy 2: Pre-event planning should be tailored at individual health-care facilities to identify commonly used critical care products and alternatives for which providers at the facility already have some degree of familiarity. To limit adverse events, it is preferable to use alternative products already in use and familiar to health-care workers rather than similar product alternatives with which they may have little experience. As such, determining alternative agents in pre-event planning requires multidisciplinary provider engagement. starlix medication
Strategy 3: Use of computer systems that integrate purchasing, storage, and use of medical supplies through technologies such as radio-frequency identification or other bar code system will allow a health-care facility to assess its real-time inventory and use of medications and medical supplies. The ability to track medication and supply levels in real time will alert a facility to predictable patterns of increased use (eg, increased use of masks during influenza season) and provide information on how much inventory is on hand at any given time.
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Care of the Critically ill and Injured During Pandemics and Disasters: Strategy 1

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In critical care medicine, supply chain vulnerabilities have already resulted in many key medication shortages, including antimicrobials, sedatives, vasopressor medications, and anesthetics (Table 2, e-Table 1). These shortages are not due to disasters, and, hence, when disasters occur, they will exacerbate these preexisting vulnerabilities. cheap wellbutrin
When medication shortages occur, alternative agents are often used, but they are often associated with suboptimal results or adverse events. Reasons attributed to inferiority of these substitutes include a lack of familiarity with the substituted medications, inherent increased toxicity of the alternative agent, and others, such as increased antimicrobial resistance rates. Even when substitutions can be made without immediate clinical consequences, they may lead to increased costs or use of a branded medication and a substantial increased time and effort by providers, pharmacists, and hospital administrators to address shortages.
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Care of the Critically ill and Injured During Pandemics and Disasters: Results

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Care of the Critically ill and Injured During Pandemics and Disasters: ResultsPeriodic disruptions in medical supply chains can occur along the continuum of the manufacturing process from the availability of raw materials to final packaging and distribution. Although large-scale disasters can result in large and far-reaching shortages of a wide array of manufactured goods, substantial supply chain disruptions can be caused by seemingly benign events, such as normal fluctuations in materials and labor or even a manufacturing platform upgrade.’ An example of the dramatic impact of seemingly unrelated events on availability of medical supplies was the global shortage of medical examination gloves in the summer of 2008 due, in large part, to the temporary scheduled closure in China of one of the world’s largest manufacturers of medical examination gloves in an effort to improve air quality during the 2008 Beijing Olympic Games.”
The increased global manufacturing interdependence also introduces quality assurance variability to medications and medical supplies. Lapses in quality assurance have led to fatal hypersensitivity reactions caused by manufacturing defects in IV heparin and fatal fungal meningitis caused by contamination of IV methylprednisolone acetate.
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Care of the Critically ill and Injured During Pandemics and Disasters: Materials and Methods

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The Business and Continuity of Operations panel followed the American College of Chest Physicians (CHEST) Guidelines Oversight Committee’s methodology to develop suggestions, based on a consensus development process (see “Methodology” article by Ornelas et al in this consensus statement). The Business and Continuity of Operations panel developed 13 key questions. (See e-Appendix 1 for key questions list, corresponding search terms and results, and data tables if sufficient evidence found). A systematic literature review was then performed for relevant articles and documents, reports, and gray literature reported since 2007 to 2012; English language papers were included, and non-English language papers were excluded. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process.  We suggest highest priority critical care supplies and medications needed for routine day-to-day care, and crucial in mass casualty events, for which no substitutions are available be identified (eg, ventilator circuits, N95 masks, insulin, etc). Once identified, dual sourcing should be used for routine purchasing of these key supplies and medications to reduce the impact of a supply chain disruption. natural breast enhancement pill
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Care of the Critically ill and Injured During Pandemics and Disasters

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Care of the Critically ill and Injured During Pandemics and DisastersBusiness and Continuity of Operations in a disaster is a broad area; therefore, the task force chose to focus on medication/medical supply shortages and continuity of information technology (IT) operations, as they are both key issues affecting critical care patients identified by several of the topic groups (see “Evacuation of the ICU” article by King et al, “Surge Capacity Principles” article by Hick et al, “Surge Capacity Logistics” article by Einav et al, ’’System Level Planning, Coordination, and Communication” article by Dichter et al, and “Triage” article by Christian et al in this consensus statement) as enablers.
Industrial globalization, including manufacturing of medications and medical supplies, has helped to increase production and reduce costs, allowing for the wide availability of products throughout the world. However, as production now depends on the integration of increasingly interdependent global networks of raw materials, manufacturing, packaging, and distribution, globalization has also contributed to increased vulnerability of the medical supply chain to disruptions caused by natural and man-made events. As such, there are steps health-care institutions should take to help prepare and account for potential medical supply chain disruptions, especially shortages of key critical care medications and supplies, regardless of the location of the disruption. Continue reading this post…

Continuous Oxygen Saturation Monitoring during Cardiac Catheterization in Adults: Conclusion

In an attempt to determine the factors that would be most predictive of arterial oxygen desaturation, we examined factors related to minimum Sa02. Three factors were found to be independent predictors: (1) low baseline Sa02; (2) the duration of the procedure; and (3) indices of left ventricular failure such as increased pulmonary arterial diastolic pressure, pulmonary capillary wedge pressure, end-diastolic volume, and decreased cardiac index. Five (63 percent) of the eight patients with symptoms or signs of heart failure before catheterization had episodes of arterial hypoxemia (Sa02 <90 percent) during the procedure. Thus, patients with congestive heart failure before catheterization or ventricular dysfunction found at catheterization are at increased risk of hypoxemia. buy antidepressants online Continue reading this post…

Continuous Oxygen Saturation Monitoring during Cardiac Catheterization in Adults: Discussion

Continuous Oxygen Saturation Monitoring during Cardiac Catheterization in Adults: DiscussionArterial hypoxemia may be associated with arrhythmias, myocardial ischemia, myocardial infarction, or congestive heart failure in the patient with coronary artery or valvular heart disease. It is difficult to predict, in any particular patient, the oxygen tension necessary to prevent morbidity; however, an arterial oxygen tension (Pa02) less than 60 mm Hg is considered by most authorities to be hypoxemic. A value for Sa02 of 90 percent corresponds approximately to a Pa02 of 60 mm Hg. In addition, Sa02 of 90 percent is at the steep portion of the oxygen-hemoglobin dissociation curve, where a small decrease in Pa02 will cause a large decrease in the amount of oxygen carried by hemoglobin. Therefore, we considered Sa02 less than 90 percent to represent arterial hypoxemia in our population. diabetes medications Continue reading this post…

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